Eastern Democratic Republic Of The Congo Research Articles

Assessment of prevalence and determinants of anxiety and psychological distress symptoms in Ebola child and adolescent survivors and orphans in Eastern Democratic Republic of the Congo during the COVID-19 pandemic

BackgroundTo date, only three studies investigated the mental health of youth affected by Ebola virus disease (EVD). None explored anxiety and psychological distress symptoms in survivors or orphans. This study aimed to investigate the prevalence and determinants of anxiety and psychological distress symptoms among survivors and orphans of the 2018–2020 Ebola epidemic in Eastern Democratic Republic of the Congo (DRC) during the COVID-19 pandemic. MethodsA representative sample of 416 participants (mean age = 13.37, SD = 2.79, 51.20 % girls, 146 survivors, 233 orphans, and 34 orphan-survivor participants) completed measures evaluating anxiety, psychological distress, exposure, resilience, stigmatization related to Ebola and COVID-19. Results55.88 % and 55.96 % of survivors and orphans experienced severe symptoms of anxiety and psychological distress. Participants who were both survivors and orphans presented higher prevalence of anxiety and psychological distress (94.12 % and 100 %) compared to survivors (74.03 % and 81.82 %) or orphans (37.99 % and 33.33 %), χ2 = 70.63, p < .001; χ2 = 113.50, p < .001. Ebola and COVID-19 related stigmatization were the most important determinants of anxiety (B = 0.40, p < .001; B = 0.37, p < .001) and psychological distress (B = 0.48, p < .001; B = 0.44, p < .001). Resilience was negatively associated with both anxiety and psychological distress. The final regression models explained 49 % and 85 % of the variance of anxiety and psychological distress. LimitationsThe cross-sectional design used prevents to establish causal link. ConclusionsEbola children and adolescents' survivors and orphans are at major risk of experiencing anxiety and psychological distress in Eastern RDC affected by years of armed conflict. Massive resources are needed to develop and implement programs to reduce stigma and support mental health.

Neonatal surgical mortality at a low resource setting, HEAL Africa tertiary hospital, Eastern Democratic Republic of the Congo.

This study describes the experience with common neonatal surgical conditions and their outcomes at a single center in the Eastern Democratic Republic of the Congo (DRC) over a period of 7years (2016-2022). A retrospective review of neonatal surgical admissions and their outcomes was performed for patient admitted between January 2016 and December 2022 at HEAL Africa teaching hospital. Data were collected from the neonatal admission and discharge registry for all patients with a potential surgical condition. 107 neonates potentially requiring surgery were identified. 81.3% were referred from facilities within 10km of HEAL Africa. The most common diagnosis was myelomeningocele/meningocele (27.1%). 68.2% of patients had an operation. The overall mortality was 29% for all patients and mean length of stay 9.9days. Operated patients had a lower mortality at 16.4% (p-value < 0.001, OR 0.155, CI 0.062-0.389) while patients with a birth weight of less than 2500g were more likely to die (p-value < 0.001, OR 5.333, CI 2.062-13.79). The neonatal mortality rate for patients presenting with a potential surgical condition is extremely high. This is multifactorial and largely related to patient selection inherent to resource limitations.

Close Proximity to Mining Is Associated with Increased Prevalence of the Drug Resistance-Associated Mutation dhps540E in Eastern Democratic Republic of the Congo.

Increasing sulfadoxine-pyrimethamine (SP) resistance in the Democratic Republic of the Congo (DRC) has threatened its use for prevention of malaria in one of the most malarious countries in the world. Using geographic information on mining operations in the DRC and genetic data on SP drug resistance markers from the 2013-2014 Demographic and Health Surveys, we evaluated associations between close residence to mining and the presence of mutations conferring resistance to sulfadoxine. Close residential proximity to mining was associated with increased prevalence odds ratio (POR) of the dhps540E mutation (POR: 2.11, 95% uncertainty interval: 1.15-3.96) with adjustments for confounding variables and space. Our findings indicate that exposure to mining is associated with increased presence of an antimalarial drug resistance haplotype that threatens effective use of SP for vulnerable populations. Areas actively engaged in mining could be considered for interventions to reduce the spread of emerging drug resistance in the DRC.

Spatiotemporal Modeling of Cholera, Uvira, Democratic Republic of the Congo, 2016-2020.

We evaluated the spatiotemporal clustering of rapid diagnostic test-positive cholera cases in Uvira, eastern Democratic Republic of the Congo. We detected spatiotemporal clusters that consistently overlapped with major rivers, and we outlined the extent of zones of increased risk that are compatible with the radii currently used for targeted interventions.

Visitation patterns of endangered grey parrots (Psittacus erithacus) in a forest clearing in the Democratic Republic of the Congo.

The grey parrot (Psittacus erithacus), once abundant, has become increasingly threatened due to the combined effects of capture for the global pet trade and habitat loss. Although grey parrots are well studied in captivity, effective conservation efforts require a better understanding of their ecological requirements in the wild. The aim of this paper is to quantify grey parrot behaviours across the annual cycle. To do that, we studied groups of grey parrots gathering in a natural forest clearing in the Nkuba Conservation Area, eastern Democratic Republic of the Congo. Using parrot counts and focal sampling, combined with descriptive statistics, we found that an average of 40 grey parrots visited the clearing each day, following a regular pattern in which they first perched in the trees surrounding the clearing, vocalizing loudly, until the group landed in the clearing to feed, drink and interact with each other. Generalized linear models (GLMs) and generalized additive models (GAMs) showed that the time at which parrots arrived, landed at, and left clearings was influenced by the weather, seasonality and the month of the year. We also found that parrots shortened their visits when disturbed by predators or the presence of humans. Although the underlying mechanisms for grey parrot visits to forest clearings remains unclear, the consistency of this behaviour observed elsewhere in Africa and the feeding observed in the clearing in this study suggest that these area support important foraging habitat for the wild grey parrots. Therefore, ensuring the availability of such clearings is paramount to the long-term survival of the species. We suggest that future efforts to protect grey parrots in their native habitats focus on identifying clearings visited by parrots, monitoring these clearings and allowing parrots to visit them without disturbance or risk of capture.

Intersecting realities: Exploring the nexus between armed conflicts in eastern Democratic Republic of the Congo and Global Health

The eastern Democratic Republic of the Congo (DRC) grapples with entrenched armed conflicts, creating a complex humanitarian crisis with far-reaching implications for global health. This paper explores the intersection between armed conflict in the region and the risks of zoonotic disease transmission, shedding light on interconnected challenges and proposing integrated strategies for mitigation. Armed conflict disrupts healthcare systems, affecting healthcare facilities (HCF) and healthcare workers (HCW), destroying millions of lives, impoverishing communities, and weakening surveillance systems. This deleterious situation is a bottleneck to achieving the Sustainable Development Goals (SDGs), especially Universal Health Coverage (UHC), as it prevents millions of Congolese from accessing healthcare services. The direct impact of armed insecurity undermines Global Health Security (GHS) by fostering natural habitat degradation and biodiversity loss, exacerbating vulnerabilities to zoonotic disease outbreaks. Forced population displacement and encroachment on natural habitats amplify human-wildlife interaction, facilitating zoonotic disease spillover and increasing the risk of regional and global spread. Biodiversity loss and poaching further compound these challenges, underscoring the need for holistic approaches that address both conservation and public health concerns. Mitigating zoonotic disease risks requires strengthening surveillance systems, promoting community engagement, and integrating conservation efforts with conflict resolution initiatives. By adopting a comprehensive approach, including the incorporation of One Health considerations in all peace-seeking and humanitarian efforts, stakeholders can enhance Global Health Security, scale up UHC, and promote sustainable development in conflict-affected regions. Creativity and strategic foresight are essential to safeguarding the well-being of human, livestock, plant, and wildlife populations in the Eastern DRC.

Mapping Flows in the Cassava, Rice, Milk, and Fish Supply Chains of the Eastern Democratic Republic of the Congo: Is There Any Quiet Revolution Taking Place?

By applying a stacked survey approach to farmers, processors, and intermediaries, this study estimates and maps aggregate flows of fresh and processed cassava, rice, milk, and fish within the Bukavu-Uvira-Kalemie economic corridor of the Eastern Democratic Republic of the Congo (DRC). To achieve this, we develop and implement a comprehensive accounting method to better capture the complex set of activities within all four supply chains as well as an alignment procedure to ensure consistency in flows across their stacks. Apart from operating beyond mere subsistence levels, the findings of this study indicate that much of the vibrant agri-food value chain (AVC) developments observed in other low- and middle-income countries (LMIC) are yet to occur in the Eastern DRC: processing levels and new product development are low; intermediaries remain very present in agri-food markets; food losses are high in the midstream segments; and advance payments to farmers have not disappeared. While these observations provide for a dissonant case study, it underscores the huge potential for future upgrading of AVC in the Eastern DRC.

Effect of a Water, Sanitation, and Hygiene Program on Handwashing with a Cleansing Agent among Diarrhea Patients and Attendants in Healthcare Facilities in the Democratic Republic of the Congo: A Randomized Pilot of the PICHA7 Program.

Healthcare-acquired infections are a major problem in healthcare facility settings around the world. The Democratic Republic of the Congo (DRC) has over 2 million diarrhea patients hospitalized each year. These healthcare settings become high-risk environments for spreading diarrheal illnesses such as cholera. The objective of the Preventative Intervention for Cholera for 7 Days (PICHA7) program is to develop evidence-based water, sanitation, and hygiene (WASH) interventions to reduce cholera and other severe diarrheal diseases in the DRC. The study objective was to evaluate the effectiveness of PICHA7 program delivery in increasing handwashing with a cleansing agent at stool/vomit- and food-related events in a healthcare facility setting among diarrhea patients and patient attendants. A pilot of the PICHA7 program was conducted among 284 participants in 27 healthcare facilities from March 2020 to November 2021 in urban Bukavu in the South Kivu Province of the DRC. The standard arm received the standard message provided in the DRC to diarrhea patients on the use of oral rehydration solution and a basic WASH message at healthcare facility discharge. The PICHA7 arm received the PICHA7 WASH pictorial module delivered by a health promoter focused on handwashing with a cleansing agent at the bedside of the diarrhea patient in the healthcare facility and provision of a soapy water bottle (water and detergent powder). Within 24 h of intervention delivery, a three-hour structured observation of handwashing practices at stool/vomit- and food-related events (key events) was conducted in healthcare facilities of diarrhea patients and their attendants. Compared to the standard arm, there was significantly more handwashing with a cleansing agent at key events in the PICHA7 arm (40% vs. 15%) (odds ratio: 5.04; (95% confidence interval (CI): 2.01, 12.7)). These findings demonstrate that delivery of the PICHA7 WASH pictorial module and provision of a soapy water bottle to diarrhea patients and their attendants presents a promising approach to increase handwashing with a cleansing agent among this high-risk population in healthcare facilities in the eastern DRC.

Evaluation of a rapid diagnostic test for detection of Vibrio cholerae O1 in the Democratic Republic of the Congo: Preventative intervention for cholera for 7 days (PICHA7 program).

Globally, there are estimated to be 2.9 million cholera cases annually. Early detection of cholera outbreaks is crucial for resource allocation for case management and for targeted interventions to be delivered to stop the spread of cholera. In resource limited settings such as Eastern Democratic Republic of the Congo (DRC), there is often limited laboratory capacity for analysing stool samples for cholera by bacterial culture. Therefore, rapid diagnostic tests (RDTs) for cholera present a promising tool to rapidly test stool samples in a health facility setting for cholera. Our objective is to evaluate the Crystal VC O1 RDT for cholera detection compared with bacterial culture and polymerase chain reaction (PCR) for Vibrio cholerae. From March 2020 to December 2022, stool samples were collected from 644 diarrhoea patients admitted to 94 health facilities in Bukavu in Eastern DRC. Patient stool samples were analysed by Crystal VC O1 RDT for cholera and by bacterial culture and PCR for V. cholerae O1. Twenty six percent of diarrhoea patients (166/644) had stool samples positive for cholera by RDT, and 24% (152/644) had stool samples positive for V. cholerae O1 by bacterial culture or PCR. The overall specificity and sensitivity of the Crystal VC O1 RDT by direct testing was 94% (95% confidence interval [CI]: 92%-96%) and 90% (95% CI, 84%-94%), respectively, when compared with either a positive result by bacterial culture or PCR. Our findings suggest that the Crystal VC O1 RDT presents a promising tool for cholera surveillance in this cholera endemic setting in sub-Saharan Africa.

Rhabdomyolysis, Acute Kidney Injury, and Mortality in Ebola Virus Disease: Retrospective Analysis of Cases From the Eastern Democratic Republic of the Congo, 2019.

Skeletal muscle injury in Ebola virus disease (EVD) has been reported, but its association with morbidity and mortality remains poorly defined. This retrospective study included patients admitted to 2 EVD treatment units over an 8-month period in 2019 during an EVD epidemic in the Democratic Republic of the Congo. An overall 333 patients (median age, 30 years; 58% female) had at least 1 creatine kinase (CK) measurement (n = 2229; median, 5/patient [IQR, 1-11]). Among patients, 271 (81%) had an elevated CK level (>380 U/L); 202 (61%) had rhabdomyolysis (CK >1000 IU/L); and 45 (14%) had severe rhabdomyolysis (≥5000 U/L). Among survivors, the maximum CK level was a median 1600 (IQR, 550-3400), peaking 3.4 days after admission (IQR, 2.3-5.5) and decreasing thereafter. Among fatal cases, the CK rose monotonically until death, with a median maximum CK level of 2900 U/L (IQR, 1500-4900). Rhabdomyolysis at admission was an independent predictor of acute kidney injury (adjusted odds ratio, 2.2 [95% CI, 1.2-3.8]; P = .0065) and mortality (adjusted hazard ratio, 1.7 [95% CI, 1.03-2.9]; P = .037). Rhabdomyolysis is associated with acute kidney injury and mortality in patients with EVD. These findings may inform clinical practice by identifying laboratory monitoring priorities and highlighting the importance of fluid management.

Complete Genome Sequencing, Annotation, and Mutational Profiling of the Novel Clade I Human Mpox Virus, Kamituga Strain.

Human Mpox (formerly monkeypox) infection is an emerging zoonotic disease caused by the Mpox virus (MPXV). We describe the complete genome annotation, phylogeny, and mutational profile of a novel, sustained Clade I Mpox outbreak in the city of Kamituga in Eastern Democratic Republic of the Congo (DRC). A cross-sectional, observational, cohort study was performed among patients of all ages admitted to the Kamituga Hospital with Mpox infection symptoms between late September 2023 and late January 2024. DNA was isolated from Mpox swabbed lesions and sequenced followed by phylogenetic analysis, genome annotation, and mutational profiling. We describe an ongoing Clade I Mpox outbreak in the city of Kamituga, South Kivu Province, Democratic Republic of Congo. Whole-genome sequencing of the viral RNA samples revealed, on average, 201.5 snps, 28 insertions, 81 deletions, 2 indels, 312.5 total variants, 158.3 amino acid changes, 81.66 intergenic variants, 72.16 synonymous mutations, 106 missense variants, 41.16 frameshift variants, and 3.33 inframe deletions across six samples. By assigning mutations at the proteome level for Kamituga MPXV sequences, we observed that seven proteins, namely, C9L (OPG047), I4L (OPG080), L6R (OPG105), A17L (OPG143), A25R (OPG151), A28L (OPG153), and B21R (OPG210) have emerged as hot spot mutations based on the consensuses inframe deletions, frameshift variants, synonymous variants, and amino acids substitutions. Based on the outcome of the annotation, we found a deletion of the D14L (OPG032) gene in all six samples. Following phylogenetic analysis and whole genome assembly, we determined that this cluster of Mpox infections is genetically distinct from previously reported Clade I outbreaks, and thus propose that the Kamituga Mpox outbreak represents a novel subgroup (subgroup VI) of Clade I MPXV. Here we report the complete viral genome for the ongoing Clade I Mpox Kamituga outbreak for the first time. This outbreak presents a distinct mutational profile from previously sequenced Clade I MPXV oubtreaks, suggesting that this cluster of infections is a novel subgroup (we term this subgroup VI). These findings underscore the need for ongoing vigilance and continued sequencing of novel Mpox threats in endemic regions.

Psychosocial impact of surgical complications and the coping mechanisms among surgeons in Uganda and Eastern Democratic Republic of the Congo.

We aimed to assess the psychosocial impact from postoperative complications on the surgical workforce and the coping mechanisms they use following these complications in Uganda and Eastern Democratic Republic of the Congo (DRC). This was a cross-sectional multi-center study conducted from first February 2022 to 31st March 2022 in the preselected main teaching hospitals of Uganda and Eastern DRC. We surveyed the surgical workforce (practicing surgeons, Obstetrician-Gynecologists, and residents in surgery/ Obstetrics-Gynecology) who had experienced postoperative complications in their career. Data was analysed using SPSS version 23. One hundred ninety-eight participants responded to the questionnaire. Worry about patient and reputation were the commonest psychological impacts in 54.0% and 45.5% of the participants respectively. Majority of the participants (55.1%) used positive coping mechanisms with a positive impact on their practice (94.4%). Being a female doctor (AOR = 2.637, CI 1.065-6.533, P = 0.036), worrying about reputation (AOR = 3.057, CI = 1.573-5.939, P = 0.001) and guilt after a complication (AOR = 4.417, CI = 2.253-8.659, P = <0.001) were predictors of a negative coping mechanism. Postoperative surgical complications continue to cause a huge psychological impact on the operating doctors in Uganda and the Eastern DRC. Female doctors, those that worry about the reputation and those that feel guilty following a complication should be given more support and guidance by peers when surgical complications occur to their patients.

The Real Effects of Supply Chain Transparency Regulation: Evidence from Section 1502 of the Dodd–Frank Act

ABSTRACTSection 1502 of the Dodd–Frank Act requires SEC‐registered issuers to conduct supply chain due diligence and submit conflict minerals disclosures (CMDs) that indicate whether their products contain tantalum, tin, tungsten, or gold (3TG) sourced from the Democratic Republic of the Congo (DRC) or its neighboring countries (“covered countries”). Consistent with the reputational cost hypothesis, we find that heightened public attention to CMDs increases responsible sourcing. After Section 1502 takes effect, we find higher demand for 3TG products processed in certified smelters, decreased conflicts in covered countries’ mining regions relative to other regions, and reduced sensitivity of conflict risk to conflict minerals’ price spikes. Finally, we find that conflicts decrease in Eastern DRC territories with prevalent 3T (tantalum, tin, and tungsten) mines but increase in territories with prevalent gold mines. Overall, our findings highlight the real effects of enhanced supply chain transparency regulation.

Family planning in the Eastern Democratic Republic of the Congo: personal beliefs, intimate partner negotiations and social pressure

The Democratic Republic of the Congo (DRC) has a low prevalence of family planning use. Recent studies have highlighted the significant role that socio-cultural factors play in the decision to use family planning or not. This qualitative study explored barriers to women’s use of family planning methods in an ongoing conflict region, South-Kivu, DRC. Focus group discussions and individual in-depth interviews were conducted to understand perceptions and habits regarding family planning. An inductive approach was used to analyse the data. Precariousness of life, religious beliefs and fear of side effects were limiting factors to the use of family planning. Power relations within the couple also played an important role in decision-making. Sole provider (‘breadwinner’) women were more likely to use family planning, including hormonal methods. Our findings highlight the continued importance of family planning programmes that respond to socio-cultural factors, personal beliefs, and fear of side effects in parallel with addressing availability and accessibility. This will require including the community in their design and implementation in order to meet unmet family planning needs. Health care providers’ capacity building and training to help women manage family planning side effects will also be beneficial.

Engaging men in women’s empowerment: impact of a complex gender transformative intervention on household socio-economic and health outcomes in the eastern democratic republic of the Congo using a longitudinal survey

BackgroundIn the Democratic Republic of the Congo, women in (peri-)urban areas are commonly engaged in small trade, which allows them to meet the basic needs of their families. Microsaving approaches are a low-risk option to obtain financing for economic activities. A project combining men’s sensitization on gender equity and women’s empowerment through village savings and loan associations were implemented in North and South Kivu to raise the household economic level.ObjectiveThis study assessed how involving men in gender equity affects women’s health and socio-economic outcomes, including food security.MethodsA cohort study was conducted with 1812 women at the baseline; out of them 1055 were retrieved at the follow-up. Baseline data collection took place from May to December 2017 and the follow-up from July 2018 to January 2019. To identify socio-economic changes and changes of gender relations, linear and logistic regressions were run.ResultsResults showed that the household income improved with intervention (coefficient = 0.327; p = 0.002), while the capacity to pay high bills without contracting debts decreased (coefficient = 0.927; p = 0.001). We did not find enough statistically significant evidence of the influence of the intervention on skilled birth attendance (coefficient = 0.943; p = 0.135), or family planning use (coefficient = 0.216; p = 0.435) nor women’s participation in the decision-making (coefficient = 0.033; p = 0.227) nor on couple’s cohesion (coefficient = 0.024; p = 0.431). Food insecurity levels decreased over time regardless of being in the intervention or control area.ConclusionEmpowering women while sensitizing men on gender aspects improves financial well-being (income). Time, security, and strong politics of government recognizing and framing the approach are still needed to maximize the benefit of such projects on social factors such as women’s participation in decision-making and social cohesion.

Effect of early vitamin D supplementation on the incidence of preeclampsia in primigravid women: a randomised clinical trial in Eastern Democratic Republic of the Congo

BackgroundPrevious studies have reported the association between maternal vitamin D deficiency and preeclampsia. However, the efficacy of vitamin D supplementation in reducing the occurrence of preeclampsia remains unclear. The objective of this study was to evaluate the effect of cholecalciferol supplementation on the incidence of preeclampsia in primigravid women and its related maternal and foetal outcomes.MethodsA single-blinded clinical trial was conducted in fourteen antenatal care health facilities in the North (Goma, Mwesso, Nyiragongo) and South Kivu (Bukavu-Panzi) provinces of the Democratic Republic of Congo from March 1, 2020, to June 30, 2021. A total of 1300 primigravid women not exceeding 16 weeks of gestation were randomised with a 1:1 ratio to either the supplemented (A) or control (B) group. Each pregnant woman (A) presenting for antenatal care received a single monthly dose of cholecalciferol (60,000 IU) orally for 6 months. The control group received no vitamin D supplementation or placebo. Serum 25(OH)D was measured at recruitment and at 34 weeks of gestation. Outcomes were assessed monthly until delivery.ResultsThe median maternal age was 21 years (14–40), while the median gestational age was 15 weeks (5.4–29.0). A significant reduction in the risk of preeclampsia [RR = 0.36 (0.19–0.69); p = 0.001] and preterm delivery [RR = 0.5 (0.32–0.78); p = 0.002] was observed in the intervention group. An RR of 0.43 [(0.27–0.67); p < 0.001] was found for low birth weight. The RR for caesarean section was 0.63 [(0.52–0.75); p < 0.001]. The APGAR score at the 5th minute (p = 0.021) and the size of the newborn were significantly higher in the supplemented group (p = 0.005).ConclusionA single monthly dose (60,000 IU) of vitamin D supplementation, started in earlypregnancy, significantly reduced the incidence of preeclampsia and its maternal and foetal complications.Trial registrationISRCTN Register with ISRCTN46539495 on 17 November 2020.

Cholera Deaths During Outbreaks in Uvira, Eastern Democratic Republic of the Congo, 10-35 Months After Mass Vaccination.

Our understanding of the burden and drivers of cholera mortality is hampered by limited surveillance and confirmation capacity. Leveraging enhanced clinical and laboratory surveillance in the cholera-endemic community of Uvira, eastern Democratic Republic of Congo, we describe cholera deaths across 3 epidemics between September 2021 and September 2023 following mass vaccination.

Can Environmental Peacebuilding Tools Effectively Combat Terrorism in the Democratic Republic of the Congo?

Since the 2014 breakout campaign of the Islamic State (IS) in Iraq and Syria, IS affiliates have proliferated across the African continent. Given the consistent failure of military campaigns against violent extremist groups (VEGs), policymakers have begun to explore the use of alternative tools like environmental peacebuilding to address the root causes of these conflicts. This paper discusses trends in violent extremism in Africa; highlights the relationship between the environment, conflict, and peacebuilding; and assesses the utility of employing environmental peacebuilding frameworks to combat the Allied Democratic Forces (ADF), an IS affiliate in the Eastern Democratic Republic of the Congo (DRC). The author finds that while environmental peacebuilding may slow recruitment by VEGs in Africa and could reduce conflict within the DRC, it is unlikely that such strategies would effectively stop the Allied Democratic Forces because the group is not primarily reliant upon locally generated funding, does not draw voluntary recruits locally, and relies rather little on the local population for support.

The Suitability of the Mandate Used by the United Nations Humanitarian Military Intervention in North Kivu Province, Eastern Democratic Republic of Congo, 2004-2022

North Kivu is one of the provinces in Eastern Democratic Republic of the Congo (DRC) where conflict seems to defy the multiple interventions by a number of national, regional and international organizations. It hosts several United Nations Humanitarian Military Intervention (UNHMI) bases and has shown a humanitarian crisis resulting from the conflict in Eastern DRC including hostilities by the armed groups. This study interrogated the suitability of the mandate used by the UNHMI through the United Nations Organization Stabilization Mission in the Democratic Republic of the Congo (MONUSCO) between 2004 and 2022. This study was informed by two complementary theories namely; Realism and New Institutionalism. Realism argued that that humanitarian military intervention by the UN in Eastern DRC was motivated by the need to promote the geopolitical interests of powerful states. New Institutionalism on the other hand contended that North Kivu province was characterized by weak institutions and there was lack of trust between the different actors. This study took the form of an exploratory research design employing the use of both primary and secondary sources. Purposive and snow ball sampling techniques were used to select 99 respondents who included 19 representatives from international humanitarian organizations in North Kivu, 20 representatives from the civil society, 10 government officials, 15 experts in conflict management, 15 security specialists, and 20 Congolese nationals. Questionnaires and interview schedules were the main research instruments. The study concluded that in as much as the UNHMI was suitable in the context of conflict management, the operation faced a number of setbacks. The study recommended that the government of DRC, taking advantage of the suitability of the Mandate of UNHMI, should cooperate with and provide more support to MONUSCO in addressing the conflict.

A Quantitative and Qualitative Program Evaluation of a Case-Area Targeted Intervention to Reduce Cholera in Eastern Democratic Republic of the Congo.

Individuals living near cholera patients have an increased risk of cholera infections. Case-area targeted interventions (CATIs) promoting improved water, sanitation, and hygiene (WASH) present a promising approach to reducing cholera for those residing near cholera cases. However, there is limited evidence on the effectiveness and implementation of this approach in increasing WASH behaviors. We conducted a mixed-methods program evaluation in rural and urban eastern Democratic Republic of the Congo. The quantitative component included household structured observations and spot checks in CATI and control areas to assess WASH conditions and behaviors. The qualitative component included semi-structured interviews with CATI recipients, non-recipients, and implementers to assess CATI implementation. A total of 399 participants were enrolled in the quantitative evaluation conducted within 1 month of CATI delivery. For the qualitative evaluation, 41 semi-structured interviews were conducted, 30 with individuals in CATI areas (recipients and non-recipients) and 11 with CATI implementers. Handwashing with soap was low among both CATI and control area participants (1% vs. 2%, p = 0.89). Significantly more CATI area households (75%) had chlorine tablets present compared to control area households (0%) (p < 0.0001); however, the percentage of households with stored water free chlorine concentrations > 0.2 mg/L was low for both CATI and control area households (11% vs. 6%, p = 0.45). Implementers reported an insufficient supply of soap for distribution to recipients and mistrust in the community of their activities. CATI recipients demonstrated low knowledge of the correct preparation and use of chlorine for water treatment. Recipients also indicated a need for CATI implementers to engage community leaders. As CATIs are part of cholera control plans in many cholera-endemic countries, it is important to evaluate existing programs and develop evidence-based approaches to deliver CATIs that are both tailored to the local context and engage affected communities to increase WASH behaviors to reduce the spread of cholera.